Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Melinda Irwin

Second Advisor

Brenda Cartmel


Background: There is currently no cure for lymphedema, thus being able to predict who islikely to develop lymphedema will allow for early intervention. To date, no study has examined the association between metabolic and inflammatory biomarkers and lower limb lymphedema (LLL) in women with ovarian cancer. This secondary analysis seeks to explore the association between serum blood biomarkers and LLL in women with ovarian cancer and determine if the change in biomarkers over time is associated with a change in lymphedema status. Methods: Data from the Women’s Activity and Lifestyle Study in Connecticut (WALC), a 6- month exercise intervention randomized controlled trial (RCT) in women with ovarian cancer was utilized. LLL assessed via self-report questionnaire, a certified lymphedema therapist, and optoelectronic perometer and blood-based biomarkers (CA-125, CRP, IGF-1, insulin, leptin, adiponectin, IL-6, TNF-α, and VEGF) were reported at baseline and 6-months. Baseline blood biomarkers were reported in their unadjusted form and when adjusting for baseline BMI, chemotherapy, cancer recurrence, and cancer stage using t-tests and ANCOVA, respectively. The change in biomarkers over the 6-month study and the change in lymphedema status was assessed via a generalized linear model. Results: The sample consisted of 88 women, mean age of 58.1 ± 8.0 years, with 19 women classified as having lymphedema at baseline via the self-report questionnaire. Baseline CA-125 levels were higher in women with lymphedema (21.01 U/mL) compared to those without lymphedema (9.94 U/mL) when adjusting for covariates (p = 0.043). A greater increase in levels of CRP (p = 0.046) and TNF-α (p = 0.016) were associated with the development of lymphedema, according to the self-report questionnaire, which occurred in 8 (11.6%) women during the 6-month study. A greater decrease in levels of CRP (p = 0.020), VEGF (p = 0.031), and leptin (p = 0.022) were associated with the resolution of lymphedema-like symptoms, according to the self-report questionnaire, which occurred in 10 (52.6%) women. Conclusion: These results show potential associations between blood biomarker levels and lymphedema status suggesting a mechanistic link as to the etiology of lymphedema. Additional research is needed to further evaluate biomarkers associated with the development of lymphedema in women newly diagnosed with ovarian cancer.


This is an Open Access Thesis.

Open Access

This Article is Open Access